Fillable I-131a Application for Travel Document (Carrier Evidence)

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I-131a Application for Travel Document (Carrier Evidence)

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The I-131a Application for Travel Document (Carrier Evidence) form is 5 pages long and contains:

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  • 37 check-boxes
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Country of origin: US
File type: PDF

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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Form I-131A 02/13/19 Page 1 of 5
Application for Travel Document (Carrier Documentation)
Department of Homeland Security
U.S. Citizenship and Immigration Services
To be completed by an
attorney or accredited
representative (if any).
Select this box if
Form G-28 or
Form G-28I is
attached.
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Action Block
Receipt
Date:
(mm/dd/yyyy)
By:
Document Hand Delivered
Document Issued
Transportation Letter Boarding Foil
For
USCIS
Use
Only
USCIS
Form I-131A
OMB No. 1615-0135
Expires 02/28/2021
Part 1. Information About You
1.b.
1.c.
1.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
START HERE - Type or print in black ink.►
Current Mailing Address (USPS ZIP Code Lookup)
3.d. City or Town
3.e. State 3.f. ZIP Code
3.g.
Postal Code
Street Number
and Name
3.b.
3.c. Flr.Apt. Ste.
3.h.
3.i. Country
Province
3.a. In Care Of Name (if any)
Date of Birth (mm/dd/yyyy)9.
6.
7.
►
A-
Alien Registration Number (A-Number)
Other Information
5.c. City or Town
5.d. State 5.e. ZIP Code
5.a.
5.b. Ste. Flr.Apt.
U.S. Physical Address
Street Number
and Name
Has your name changed since the issuance of your last
Permanent Resident Card (Form I-551)?
NoYes
2.
NOTE: If you answered "Yes" to Item Number 2., attach
evidence of your legal name change with this application.
If you answered "No" to Item Number 4., provide your
U.S. physical address in Item Numbers 5.a. - 5.e.
►
USCIS Online Account Number (if any)
U.S. Social Security Number (if any)8.
►
FemaleMaleSex10.
Is your current mailing address the same as your U.S.
physical address?
NoYes
4.
Form I-131A 02/13/19 Page 2 of 5
Since you were granted permanent residence, have you
EVER filed Form I-407, Abandonment of Lawful
Permanent Resident Status, or otherwise been judged to
have abandoned your status?
Have you EVER been issued a Travel Document? 5.a.
NoYes
Part 3. Processing Information
NoYes
4.
Are you NOW, or were you EVER, in exclusion,
deportation, removal, or rescission proceedings?
3.
NoYes
If you answered "Yes" to Item Number 3., provide
details in the space provided in Part 7. Additional
Information.
If you answered "Yes" to Item Number 4., provide details
in the space provided in Part 7. Additional Information.
If you answered "Yes" to Item Number 5.a., answer Item
Numbers 5.b. and 5.c. for the last document issued to you
and provide additional details in the space provided in
Part 7. Additional Information.
Date Departed the United States (mm/dd/yyyy)1.
Date of Intended Travel to the United States
(mm/dd/yyyy)
2.
2. At my request, the preparer named in Part 6.,
prepared this application for me based only upon
information I provided or authorized.
,
Part 2. Reason for Application
Select only one box.
My previous Permanent Resident Card has been lost,
stolen, or destroyed.
My previous Permanent Resident Card was issued but
never received.
My existing Permanent Resident Card has been
mutilated.
My existing Permanent Resident Card has already
expired.
Other (explain below).
1.a.
1.b.
1.c.
1.d.
1.e.
a language in which I am fluent, and I understood
everything.
The interpreter named in Part 5. read to me every
question and instruction on this application and my
answer to every question in
1.b.
,
I can read and understand English, and I have read
and understand every question and instruction on this
application and my answer to every question.
1.a.
Part 4. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
NOTE: Read the Penalties section of the Form 1-131A
Instructions before completing this section.
Applicant's Statement
Applicant's Daytime Telephone Number3.
Applicant's Email Address (if any)5.
Applicant's Mobile Telephone Number (if any)4.
Applicant's Contact Information
Part 1. Information About You (continued)
12. Country of Citizenship or Nationality
11. Country of Birth
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information
from any and all of my records that USCIS may need to
determine my eligibility for the immigration benefit that I seek.
Applicant's Declaration and Certification
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
records, to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
Disposition (attached, lost, etc.):5.c.
Date Issued (mm/dd/yyyy)5.b.
Form I-131A 02/13/19 Page 3 of 5
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any) 6.
Interpreter's Certification
I certify, under penalty of perjury, that:
which is the same language specified in Part 4., Item
Number 1.b., and I have read to this applicant in the
identified language every question and instruction on this
application and his or her answer to every question. The
applicant informed me that he or she understands every
instruction, question, and answer on the application, including
the Applicant's Declaration and Certification, and has
verified the accuracy of every answer.
I am fluent in English and ,
Date of Signature (mm/dd/yyyy)6.b.
Applicant's Signature6.a.
I certify, under penalty of perjury, that all of the information in
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
all of the information contained in, and submitted with, my
application and that all of this information is complete, true, and
correct.
Applicant's Signature
NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
Part 4. Applicant's Statement, Contact
Information, Declaration, Certification, and
Signature (continued)
Part 5. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Family Name (Last Name)1.a.
Interpreter's Full Name
Interpreter's Given Name (First Name)1.b.
Interpreter's Business or Organization Name (if any)2.
Provide the following information about the interpreter.
Interpreter's Signature7.a.
Date of Signature (mm/dd/yyyy)7.b.
Interpreter's Signature
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code
Street Number
and Name
3.a.
3.b. Flr.
Apt.
Ste.
3.g.
3.h. Country
Province
5. Interpreter's Mobile Telephone Number (if any)
Part 6. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
Preparer's Business or Organization Name (if any)2.
Preparer's Given Name (First Name)1.b.
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
Form I-131A 02/13/19 Page 4 of 5
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Signature
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Declaration and Certification, and
that all of this information is complete, true, and correct. I
completed this application based only on information that the
applicant provided to me or authorized me to obtain or use.
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code
Street Number
and Name
3.a.
3.b. Flr.Apt. Ste.
3.g.
3.h. Country
Province
Preparer's Contact Information
4. Preparer's Daytime Telephone Number
5. Preparer's Mobile Telephone Number (if any)
6. Preparer's Email Address (if any)
I am not an attorney or accredited representative
but have prepared this application on behalf of the
applicant and with the applicant's consent.
I am an attorney or accredited representative and
my representation of the applicant in this case
7.a.
7.b.
preparation of this application.
Preparer's Statement
does not extend beyond the extends
NOTE: If you are an attorney or accredited
representative, you may need to submit a completed
Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, or G-28I,
Notice of Entry of Appearance as Attorney In
Matters Outside the Geographical Confines of the
United States, with this application.
Part 6. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
(continued)
Form I-131A 02/13/19 Page 5 of 5
Part 7. Additional Information
If you need extra space to provide any additional information
within this application, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this application or attach a separate
sheet of paper. Type or print your name and A-Number at the
top of each sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers; and sign and
date each sheet.
A-Number ►
A-
3.a.
2.
Page Number 3.b. Part Number 3.c. Item Number
3.d.
Page Number
Part Number Item Number
Page Number Part Number Item Number5.a.
Page Number
7.a. 7.b. 7.c.
Item NumberPart NumberPage Number
5.b.
Part Number
5.c.
Item Number
5.d.
1.b.
1.c.
1.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
4.c.4.b.
4.d.
4.a.
6.d.
7.d.
6.c.6.b.6.a.
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I-131a Application for Travel Document (Carrier Evidence)

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Completed 6 November 2019

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